A new survey from the Stanford University School of Medicine suggests that a significant number of Asian Americans living in California adopt unhealthy sun-exposure behaviors as they become more westernized. The findings underscore a need for increased skin health awareness on the part of primary care physicians, dermatologists and people of Asian ancestry, who may incorrectly assume that pigmented skin and hair protect against skin cancer.

"Skin screening and self-examination recommendations, which are often targeted more to people with fair skin, should definitely include different ethnic groups," said dermatologist Anne Chang, MD, an instructor at the medical school, who noted that skin cancer rates have been reported to be rising significantly in Asians living in Singapore and Japan. "Asian Americans shouldn't derive a false sense of security from the presence of skin and hair pigmentation."

Chang and her colleagues surveyed the attitudes and behaviors of 546 Asian Americans in the study, which will be published in the May issue of the Archives of Dermatology. Study participants filled out an Internet-based questionnaire asking, among other things, about their skin type, their degree of westernization and the amount of time spent tanning outdoors or in tanning booths. More than 95% of the responses came from Northern California. In 2007, roughly one of every 10 Californians, or about 4.5 million people, was Asian American.

After correcting for age and skin type, the researchers found that respondents who were more westernized—a measure assessed by number of generations the respondent's family has lived in the United States, whether the respondent was raised mostly in Asia or the United States and how westernized he or she felt—were more likely to feel that a tan was attractive, that sunscreen was too much trouble to apply and that sun-protective clothing was less important than looking fashionable.

According to the survey responses, the more westernized Asian Americans also spent more time in the sun and were more likely to actively tan either outdoors or on tanning beds than respondents categorized as less westernized. Specifically, about 60% of the 312 respondents whose families have been in the United States for at least two generations reported lying in the sun—a rate approaching that of Caucasian Americans—to achieve a tan compared to 47% of the 234 first-generation respondents.

Where the respondents were raised also mattered: 59% of the 423 respondents who reported growing up primarily in the United States indicated that they had actively sunbathed, while 34% of the 98 people who grew up primarily in Asia reported doing so.

The data jibes with differing cultural ideas about beauty and status. Said Chang, "Traditional Asian cultures, in which a tan is associated with manual labor, tend to value light skin. However, Western media often imply that tanned skin is attractive, possibly because it is associated with outdoor leisure activities or leisurely lifestyles."

The researchers speculate that many Asian Americans may wrongly feel their darker skin pigment protects them from developing skin cancer. In fact, some Asians from northern latitudes may be equally likely as fair-skinned Europeans to burn in response to excessive sun exposure, said Chang. However, because most skin cancers are not stratified by ethnic group in the United States, it is difficult to track whether Asian Americans in California are experiencing an increase in skin cancer rates. Regardless, Chang and her colleagues urge caution.

"A lot of younger people don't think about the long-term effects of sun exposure," said Chang. "They may just want to look good in the short term for an upcoming vacation or party. But sun and ultraviolet light can cause a lot of short- and long-term damage, leading to wrinkling and facial discoloration, as well as skin cancer. In addition, ultraviolet rays from either the sun or a tanning bed have been shown to be addictive. The more you protect yourself, the happier you'll be down the road, no matter what race or ethnic group you belong to."

Chang's Stanford colleagues on the study include research associate Emily Gorrell; dermatology resident Carolyn Lee, MD, PhD; and dermatology research fellow Claudia Munoz, MD. The study received no outside sources of funding.

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